COVID-19–Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA

Abstract

Background: COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW.Methods: As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access.Results: Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3). Conclusions:Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.

COVID-19 Conspiracy Beliefs are not Barriers to HIV Status Neutral Care Among Black Cisgender Sexual Minority Men and Black Transgender Women at the Initial Peak of the COVID-19 Pandemic in Chicago, USA

“…As reported previously [ 9 ], the mean age was 27.9 years (standard deviation was 4.1), 88.3% were male, 59.7% self-identified as gay, and 38.4% were in a relationship. Among participants not living with HIV (n = 132), 90 (68.2%) were not on PrEP, 11 (8.3%) used PrEP less frequently, 26 (19.7%) used PrEP the same amount, and 5 (3.8%) used PrEP more frequently since shelter-in-place.…”

“…The methods of the N2 Chicago COVID-19 survey in Chicago, Illinois have been described in detail elsewhere. [ 9 ] In brief, we contacted all participants who completed the N2 baseline survey (January 2018–December 2019) in Chicago using various methods, including email, text, phone calls, Facebook contact, and network proxy contact (participants relayed contact details of their close friends and familiars). Due to the “shelter-in-place” order, all participants underwent virtual interviews via Zoom or mobile device with a trained interviewer at the University of Chicago’s Survey Lab.…”

“…However, even disproportionately impacted by COVID-19, Black sexual and gender minorities have the lowest COVID-19 vaccine coverage across all other race/ethnicity categories of sexual and gender minorities [ 8 ]. The synergistic effects of the HIV and COVID-19 epidemics has placed both BCSMM [ 9 , 10 ] and BTW [ 11 ] in massive physical, social, and economic crises.…”

“…HIV-related mistrust and stigma is a prioritized research agenda at the US National Institutes of Health [ 17 ]. However, research on understanding mistrust among Black sexual and gender minorities in the context of the COVID-19 pandemic is limited [ 9 – 11 ]. Much is still unknown about how BCSMM and BTW perceive COVID-19.…”

Polysubstance use in a community sample of Black cisgender sexual minority men and transgender women in Chicago during initial COVID-19 pandemic peak

“…Beginning April 20, 2020, we asked participants to complete a supplementary COVID-19 survey via Zoom platform or by phone [23]. Data collection for the survey ended on July 30, 2020, and we included the 226 baseline N2 participants who completed the survey in these analyses.…”